• By: rommel toledo, dmd,ms dent ed.

MATURITY INDICATORS
BIOLOGICAL INDICATORS OF MATURITY
• Morphological Age/ HEIGHT AGE
it is based on height gained. Height or morphological age is useful as a
maturity indicator from late infancy to early adulthood.

• Dental Age
can assessed by two different method:
- By eruption status of primary and permanent dentition
- By radiographic assessment of calcification of crowns and development of
roots of unerupted and developing teeth.
Dental age maturity indicators are useful from birth to early adolescence.

Chronological age
- age measure by years lived since is a poor indicator of maturity as it provides
little validity for identifying stages of development of progression from
adolescent of adulthood. It is unreliable because in assesing the childrens
maturational status, variation are observe in terms of timing, duration, and
velocity of growth
 • Sexual Age
it refers to the development of secondary sex characteristics: breast
development and menarches in females; penis and testes growth in
males; and axillary and public hair development in both sexes.
-sexual age as a maturity indicator is useful only for adolescent growth.

• Skeletal Age
it is determined by accessing the development of bones in the hand
and wrist or by evaluating the development of cervical vertebrae on
lateral cephalograms.
it provides a most useful means of assessing biologic maturity and is
useful through the postnatal growth.
IDEAL REQUIREMENTS OF A MATURITY
INDICATOR
• It should be safe and It should be non invasive
• Radiation exposure should be minimal
• It should be accurate
• The stages of maturity should be well defined and easily
identifiable
• The method should be simple to perform minimal
armamentarium and personnel requirements
• The method should be valid in both genders and in different
population groups
• It should be cost-effective
HAND WRIST RADIOGRAPHS
 INDICATIONS FOR HAND & WRIST
RADIOGRAPHS
• Prior to rapid maxillary expansion
• When maxillomandibular changes are indicated
• Marked discrepancy b/w chronologic and dental age
• Orthodontic patients requiring orthognathic surgery between 16
&20 yrs of age.
• Most commonly used, comprising of 28 – 30 separate centers
of bone growth and maturation
ANATOMY OF SKELETON OF THE HAND

• Distal ends of long bones of fore

arm( radius and ulna)
• Carpals
• Metacarpals
• Phalanges

• Carpal bones:
• Trapezium
• Trapezoid
• Capitate
• Hamate &
• Hamular process of the hamate
• Triquetral
• Pisiform
• Lunate
• Scaphoid
HAND WRIST RADIOGRAPH HAVE BEEN
CORR
 GROWTH CENTERS IN HAND WRIST
REGION
• Phalanges • 28(14 primary and 14
secondary)
• Metacarpals • 10(5 primary and 5
secondary)
• •8
Carpals
• •2
Ulna
• •2
Radius
• •1
Sesamoid
• • 51 sesamoid growth
Total
centers
 CARPAL BONES

• the main role of the carpus is to facilitate effective positioning

of the hand and powerful use of the extensors and flexors of the
forearm, but the mobility of individual carpal bones increase
the freedom of movements at the wrist.
 METACARPAL BONES

• long bones in miniature that are connected to the carpals, or

wrist bones, at the wrist, and connect from there to the
phalanges, or finger bones
 PHALANGES

• The bones of the fingers and of the toes. There are generally
three phalanges (distal, middle, proximal) for each digit except
the thumbs and large toes. The singular of phalanges is
phalanx.
 OSSIFICATION OF PHALANGES

• The phalanges are ossified from a primary center of the shaft

and proximal epiphyseal center.
• Ossification in the shaft (primary centers) begins prenatally.
• The epiphyseal centers (secondary centers) appear postnatally
around two to four years.
• Ossification in the epiphyses continous progressively and in the
fusion of the epiphyses with their respective diaphyses is
completed during puberty at about 15th to 16th year in females
and 17thy and 18th year in males.
 3 STAGES

• Stage 1:
the epiphysis and diaphysis are equal

• Stage 2:
the epiphysis caps the diaphysis by covering it like a cap

• Stage 3:
fusion occurs between epiphysis and the diaphysis
 THE ULNAR SESSAMOID BONE

• A small nodular bone, which is most often found embedded

within the tendons in the region of the thumb.
 METHODS

• Greulich and phyle method

• Bjork, Grave and Brown method
• Fishman’s skeletal maturity indicators
• Singer’s method
• Hog and Taranger method
 GREULICH & PYLE METHOD

• Radiograph is compared with a standard series of films,

representative of normal children at different chronological
ages and for each sex.
BJORK, GRAVE & BROWNS METHOD

• 9 developmental stages
• Area of ossification events
• Area of phalanges
• Carpal bones
• Radius
• This method describes the relationship b/w the epiphyses and
the diaphysis in 3 stages
FISHMAN’S METHOD
 SINGER’S METHOD

• A relatively rapid and easier method of skeletal maturity

assessment base on hand-wrist radiograph was developed by
Julian Singer.
 HOG & TARANGER METHOD

• Analyzed the hand wrist radiograph's of individual taken

annually between the ages of 6 and 18 years and studied the
ossification of the following bones:

Ulnar Sesamoid (S)

Certain stages of 3 epiphyseal bones
THANK YOU ☺